Man­euv­er­ing around last-second snags with some back­room in­trigue, House GOP lead­ers used a voice vote Thursday to pass an­oth­er tem­por­ary patch to pre­vent a massive cut to doc­tors’ Medi­care pay­ments.

The de­cision by Re­pub­lic­an lead­ers to cir­cum­vent the planned roll-call vote caught many of their own mem­bers by sur­prise.

Demo­crats could have op­posed the pro­cess and de­man­ded a roll-call vote be taken, but House Minor­ity Lead­er Nancy Pelosi had giv­en as­sur­ances they wouldn’t do that. At the very least, the use of a voice vote does not provide the pub­lic with a re­cord of who ac­tu­ally sup­por­ted the meas­ure and who op­posed it.

The voice vote oc­curred without fan­fare after a series of closed-door meet­ings between House GOP lead­ers and some rank-and-file mem­bers — in­clud­ing mem­bers of the GOP doc­tors’ caucus who op­posed do­ing an­oth­er stop-gap fix but were ap­prised of the voice-vote strategy be­fore it happened.

Doc­tors groups, such as the Amer­ic­an Med­ic­al As­so­ci­ation, have been lob­by­ing for a per­man­ent change in Medi­care’s pay­ment for­mula rather than the tem­por­ary patches Con­gress al­ways passes.

Adding an­oth­er hurdle was that Demo­crats on Thursday morn­ing took to the House floor to de­nounce the tem­por­ary patch in the “doc fix,” or more form­ally, the Sus­tain­able Growth Rate, in fa­vor of a per­man­ent fix.

“It is un­for­tu­nate that we have been put in this po­s­i­tion with less than 48 hours no­tice of what’s in this bill, to do something that all of us knows needs to be done,” House Minor­ity Whip Steny Hoy­er said.

On Wed­nes­day, Speak­er John Boehner had said the deal had been worked out with the Sen­ate to get the meas­ure done.

But with the prob­lems in­tern­ally with­in his own caucus, and the op­pos­i­tion of Demo­crats, the planned pro­cess for passing the bill was scrapped. That ex­ped­ited pro­cess would have re­quired two-thirds of the 432-seat House to vote for it, mean­ing more than 50 of the 199 Demo­crats would have had to go along, even if all Re­pub­lic­ans had sup­por­ted it.

Throughout the closed-door meet­ings, Ma­jor­ity Lead­er Eric Can­tor kept say­ing he re­mained “con­fid­ent” that House ac­tion would still oc­cur on the meas­ure and that “we are work­ing on it.” The ul­ti­mate solu­tion was to hold a voice vote that many mem­bers did not real­ize oc­curred.

Rep. Peter Welch, D-Vt., ex­pressed out­rage at the pro­cess, say­ing, “I didn’t know it happened. We should be vot­ing.”

Rep. Gerry Con­nolly D-Va., who vo­cally voted no, said there wasn’t a re­quest for re­cor­ded vote be­cause “there were con­cerns raised on the Sen­ate side not to do that,” and there was no al­tern­at­ive.

But was this any­thing oth­er than sneaky? “To quote the House of Cards, ‘You might very well say that, but I can­not com­ment that,’ ” Con­nelly said. “I’ve been dy­ing to say that.”

The House passed a $137 bil­lion per­man­ent fix on March 14, which re­lied on sav­ings tied to the re­peal of the Af­ford­able Care Act in­di­vidu­al-in­sur­ance man­date. But that was re­jec­ted by the Demo­crats who lead the Sen­ate, and it faced a pres­id­en­tial veto threat.

The tem­por­ary, smal­ler bill in­cludes spend­ing off­sets from re­duc­tions in oth­er Medi­care spend­ing; also, some of its costs are paid for by re­align­ing se­quester sav­ings set to oc­cur in 2025 to 2024.

Spe­cific­ally, the Pro­tect­ing Ac­cess to Medi­care Act of 2014 would pre­vent the 24 per­cent cut in re­im­burse­ments to doc­tors who treat Medi­care pa­tients by re­pla­cing it on April 1 with ad­op­tion of a 0.5 per­cent up­date through Dec. 1. There would be no per­cent­age changes for the three months fol­low­ing that through April 1, 2015.

Along with ex­tend­ing pay­ments un­der SGR through March of 2015, the bill also in­cludes fund­ing for vari­ous oth­er ex­pir­ing Medi­care pro­vi­sions.

"Former Secretary of State Rex Tillerson was spotted entering a congressional office building on Tuesday morning for what a committee aide told The Daily Beast was a meeting with the leaders of the House Foreign Affairs committee and relevant staff about his time working in the Trump administration. ... Tillerson’s arrival at the Capitol was handled with extreme secrecy. No media advisories or press releases were sent out announcing his appearance. And he took a little noticed route into the building in order to avoid being seen by members of the media."